Impact of community organization of women on perinatal outcome in rural Bolivia

University of Texas-Houston, School of Public Health, El Paso 79902, USA.
Revista Panamericana de Salud Pública (Impact Factor: 0.85). 01/1998; 3(1). DOI: 10.1590/S1020-49891998000100002
Source: DOAJ


An intervention to improve maternal and child health was conducted in a remote Bolivian province with limited access to modern medical facilities. The intervention focused on initiating and strengthening women's organizations, developing women's skills in problem identification and prioritization, and training community members in safe birthing techniques. Its impact was evaluated by comparing perinatal mortality rates and obstetric behavior among 409 women before and after the intervention. Perinatal mortality decreased from 117 deaths per 1 000 births before the intervention to 43.8 deaths per 1 000 births after. There was a significant increase in the number of women participating in women's organizations following the intervention, as well as in the number of organizations. The proportion of women receiving prenatal care and initiating breast-feeding on the first day after birth was also significantly larger. The number of infants attended to immediately after delivery likewise increased, but the change was not statistically significant. This study demonstrates that community organization can improve maternal and child health in remote areas.

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Available from: Lisa Howard-Grabman, Dec 22, 2014
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    • "Facilitated structured planning and action oriented women's group sessions moving from problem analysis, strategies, implementation and review in Bolivia, coincided with a decrease in perinatal mortality from 117 to 43 deaths per 1000 live births (p<0.001) and increased participation in women's organisations from 7 to 54% (p<0.001) [45]. In other sites of Bolivia this model led to 73% of participants expressing willingness to use reproductive health services [46], CPR increased from an estimated zero to 27%, clean delivery kits were newly introduced and used in 27% of homebirths, and early breastfeeding increased from 25 to 57% within 3 years [32]. "
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    ABSTRACT: Geography poses serious challenges to delivery of health services and is a well documented marker of inequity. Maternal, newborn and child health (MNCH) outcomes are poorer in mountainous regions of low and lower-middle income countries due to geographical inaccessibility combined with other barriers: poorer quality services, persistent cultural and traditional practices and lower socioeconomic and educational status. Reaching universal coverage goals will require attention for remote mountain settings. This study aims to identify strategies to address barriers to reproductive MNCH (RMNCH) service utilisation in difficult-to-reach mountainous regions in low and lower-middle income settings worldwide. A systematic literature review drawing from MEDLINE, Web of Science, Scopus, Google Scholar, and Eldis. Inclusion was based on; testing an intervention for utilisation of RMNCH services; remote mountain settings of low- and lower-middle income countries; selected study designs. Studies were assessed for quality and analysed to present a narrative review of the key themes. From 4,130 articles 34 studies were included, from Afghanistan, Bolivia, Ethiopia, Guatemala, Indonesia, Kenya, Kyrgyzstan, Nepal, Pakistan, Papua New Guinea and Tajikistan. Strategies fall into four broad categories: improving service delivery through selected, trained and supported community health workers (CHWs) to act alongside formal health workers and the distribution of critical medicines to the home; improving the desirability of existing services by addressing the quality of care, innovative training and supervision of health workers; generating demand by engaging communities; and improving health knowledge for timely care-seeking. Task shifting, strengthened roles of CHWs and volunteers, mobile teams, and inclusive structured planning forums have proved effective. The review highlights where known evidence-based strategies have increased the utilisation of RMNCH services in low income mountainous areas. While these are known strategies in public health, in such disadvantaged settings additional supports are required to address both supply and demand barriers.
    PLoS ONE 02/2014; 9(2):e87683. DOI:10.1371/journal.pone.0087683 · 3.23 Impact Factor
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    • "•Community mobilization to establish village-level core groups and to strengthen community capacity to identify and address barriers to obstetric and neonatal care such as recognition of complications and transportation to a facility to manage the complication [18]. Each village-level core group was trained to move through a cycle to organize, plan, explore, act, and to evaluate maternal and perinatal outcomes within their community. "
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    ABSTRACT: Fetal and neonatal mortality rates in low-income countries are at least 10-fold greater than in high-income countries. These differences have been related to poor access to and poor quality of obstetric and neonatal care. This trial tested the hypothesis that teams of health care providers, administrators and local residents can address the problem of limited access to quality obstetric and neonatal care and lead to a reduction in perinatal mortality in intervention compared to control locations. In seven geographic areas in five low-income and one middle-income country, most with high perinatal mortality rates and substantial numbers of home deliveries, we performed a cluster randomized non-masked trial of a package of interventions that included community mobilization focusing on birth planning and hospital transport, community birth attendant training in problem recognition, and facility staff training in the management of obstetric and neonatal emergencies. The primary outcome was perinatal mortality at >=28 weeks gestation or birth weight >=1000 g. Despite extensive effort in all sites in each of the three intervention areas, no differences emerged in the primary or any secondary outcome between the intervention and control clusters. In both groups, the mean perinatal mortality was 40.1/1,000 births (P = 0.9996). Neither were there differences between the two groups in outcomes in the last six months of the project, in the year following intervention cessation, nor in the clusters that best implemented the intervention. This cluster randomized comprehensive, large-scale, multi-sector intervention did not result in detectable impact on the proposed outcomes. While this does not negate the importance of these interventions, we expect that achieving improvement in pregnancy outcomes in these settings will require substantially more obstetric and neonatal care infrastructure than was available at the sites during this trial, and without them provider training and community mobilization will not be sufficient. Our results highlight the critical importance of evaluating outcomes in randomized trials, as interventions that should be effective may not be.Trial registration: NCT01073488.
    BMC Medicine 10/2013; 11(1):215. DOI:10.1186/1741-7015-11-215 · 7.25 Impact Factor
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    • "Each facilitator is responsible for 18 groups. She guides the groups through a four-phased community action cycle [22], in which she activates and supports the groups to identify and prioritize maternal and newborn (cycle 1), or child and women's (cycle 2), health problems (phase 1), plan strategies to address these problems (phase 2), and implement (phase 3) and evaluate (phase 4) these strategies (Figure 2). At the end of phase 2 and at the start of phase 4 community meetings will be held to engage the wider community in the development and implementation of the strategies. "
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    ABSTRACT: Background Progress on neonatal survival has been slow in most countries. While there is evidence on what works to reduce newborn mortality, there is limited knowledge on how to deliver interventions effectively when health systems are weak. Cluster randomized trials have shown strong reductions in neonatal mortality using community mobilisation with women's groups in rural Nepal and India. A similar trial in Bangladesh showed no impact. A main hypothesis is that this negative finding is due to the much lower coverage of women's groups in the intervention population in Bangladesh compared to India and Nepal. For evidence-based policy making it is important to examine if women's group coverage is a main determinant of their impact. The study aims to test the effect on newborn and maternal health outcomes of a participatory women's group intervention with a high population coverage of women's groups. Methods A cluster randomised trial of a participatory women's group intervention will be conducted in 3 districts of rural Bangladesh. As we aim to study a women's group intervention with high population coverage, the same 9 intervention and 9 control unions will be used as in the 2005-2007 trial. These had been randomly allocated using the districts as strata. To increase coverage, 648 new groups were formed in addition to the 162 existing groups that were part of the previous trial. An open cohort of women who are permanent residents in the union in which their delivery or death was identified, is enrolled. Women and their newborns are included after birth, or, if a woman dies during pregnancy, after her death. Excluded are women who are temporary residents in the union in which their birth or death was identified. The primary outcome is neonatal mortality in the last 24 months of the study. A low cost surveillance system will be used to record all birth outcomes and deaths to women of reproductive age in the study population. Data on home care practices and health care use are collected through interviews. Trial registration ISRCTN: ISRCTN01805825
    Trials 09/2011; 12(1):208. DOI:10.1186/1745-6215-12-208 · 1.73 Impact Factor
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